Consensus panel calls for specialized nutrition therapy to manage obesity

A newly published consensus report prepared by a panel of clinical experts, with sponsorship from Nestle Health Science, reveals that there are opportunities to do more to manage the impact of obesity on the delivery of critical care, particularly in the area of nutrition therapy. With more than 25 percent of ICU patients considered to be obese or severely obese, the panel of clinical experts urges hospitals and medical professionals to adapt medical care traditionally designed to meet the needs of average-weight patients to the unique needs of the obese patient population. Patients with obesity, while heterogeneous as a population, are typically predisposed to greater morbidity, higher instances of infection and organ failure, and extended length of stay, all negative clinical outcomes that affect overall recovery.

"The lack of consistent standardized nutrition interventions for the critically ill patient with obesity means that some patients may be overfed and others may be underfed or malnourished. Some may never have their nutritional needs assessed. All of these scenarios can present problems with health outcomes and recovery rates," said Dr. Stephen McClave, M.D., professor of Medicine, University of Louisville, and moderator of the consensus panel.

The consensus report, published as a supplement to the September 2011 issue of the Journal of Parenteral and Enteral Nutrition (JPEN), explores multiple issues related to obesity in the critical care setting including the many challenges associated with applying standard nutrition therapy practice to the obese patient population. Areas of concern include assessment of nutritional status and nutrient requirements, as well as delivery of nutrients, including route of delivery, overfeeding of calories, underfeeding of protein and monitoring of feeding tolerance.

"The intent of specialized nutrition support for the critically ill patient with obesity is to provide sufficient nutrients to facilitate clinical recovery, avoid adverse effects relative to the inherent metabolic complications associated with obesity, minimize protein loss, and ultimately achieve net protein anabolism during the recovery phase of the patient's hospitalization," says Roland Dickerson, Pharm. D., BCNSP, FACN, FCCP, of the University of Tennessee Health Science Center.

The panel agreed that, of the more than 200 enteral nutrition formulations available at the time of the conference, none adequately met the nutritional needs of the critically ill patient with obesity without manipulation. The panel specifically recommended a high protein, hypocaloric feeding formula to maximize protein synthesis and preserve lean body mass.

"As a leader in providing solutions that meet the nutritional challenges of all patients, Nestle Health Science has committed to collaborating with these experts to collectively identify the best approach for the critically ill patient with obesity, and focusing our efforts on their valuable insights and recommendations," said Juan Ochoa, M.D., Medical and Scientific Director for the company's  HealthCare Nutrition business.

To address this unmet need, Nestle Health Science has developed a tube feeding formulation, PEPTAMEN® BARIATRIC formula, with a unique protein-to-calorie ratio specifically designed to help meet the protein requirements of the critically ill patient with obesity recommended in the 2009 Critical Care Nutrition Guidelines.

Additionally, Nestle Nutrition Institute is sponsoring a continuing medical education activity for physicians, registered dietitians, registered nurses and pharmacists to learn about obesity in the ICU and the new recommendations for the nutritional management of the critically ill patient with obesity.

SOURCE Nestle Health Science